Partial Red Cell Exchange in the Secondary Prevention of Stroke in Sickle Cell Disease: A Prospective Study

INTRODUCTION: Stroke is a severe complication associated with sickle cell disease (SCD). The risk of recurrence is extremely high. The present study aimed to assess the clinical and biological efficacy of Partial Red Cell Exchange (PRE) in secondary stroke prevention among a cohort of Tunisian patients with SCD. PATIENTS AND METHODS: We conducted a prospective study over a 15-year period (January 1, 2010-December 31, 2024). A total of 29 patients with sickle cell syndromes complicated by one or more strokes were enrolled. They underwent 1732 PRE. RESULTS: The median age was 99 months (75-133). The median follow-up duration was 78 months (49-126). The mean HbS decreased from 40.1% ± 14.1% to 21.1% ± 11.1% post-exchange (p < 0.0001). Treatment failure was observed in 8 of 29 patients (27.5%), with a total of 12 neurological events over a cumulative treatment duration of 1570 months. 11 of 12 recurrences (91.7%) occurred within the first 4 years of the exchange program. The presence of moyamoya vasculopathy was predictive of therapeutic failure. CONCLUSIONS: PRE remains an effective modality for secondary stroke prevention in patients with sickle cell disease. Stroke recurrences occur predominantly within the first 4 years of treatment and are more frequent in the context of severe cerebrovascular disease.